Pharmassists

🙌❤️On October 29, the U.S. Department of Labor announced a major new transparency rule targeting Pharmacy Benefit Managers (PBMs). What is a PBM? A Pharmacy Benefit Manager (PBM) is a middleman between health insurance companies, drug manufacturers, pharmacies, and the people who need prescription medications. PBMs are hired to manage prescription drug benefits. Their responsibilities include: Negotiating drug prices and rebates with pharmaceutical manufacturers. Deciding which medications are included on insurance plans' approved drug lists (formularies). Determining which pharmacies are included in insurance networks. They have increasingly steered or forced many patients to the ones they own. Processing prescription claims. Negotiating how much pharmacies are reimbursed for medications. In other words, PBMs have enormous influence over which medications patients can access, what insurance plans pay, and how much pharmacies receive. Who are the BIG THREE PBMs? Three companies dominate this industry: Express Scripts – owned by Cigna. CVS Caremark – owned by CVS Health. Optum Rx – owned by UnitedHealth Group. These three companies processed approximately 80% of all equivalent prescription claims in the United States in 2025. A tremendous amount of prescription drug spending flows through just three companies. So what is happening at the Department of Labor? The Department of Labor has finalized a new rule requiring PBMs and certain affiliated brokers and consultants to disclose fees and compensation received for managing prescription drug benefits for large, self-insured employer health plans. The goal is to give employers and the people responsible for overseeing their health plans a clearer picture of where the money is going. Why does this matter? When the people negotiating drug prices, managing pharmacy networks, processing claims, and collecting compensation are not fully transparent about their financial arrangements as they force patients to their own pharmacies and oversee both competitor and their own reimbursements, employers and patients have a difficult time understanding the true cost of their prescription benefits, and many have found PBMs not acting in the best interest of anyone but themselves. Employers think they are hiring PBMs to save money on prescription drugs BUT when the PBM controls the pricing, pharmacy reimbursement, rebates, and sometimes the pharmacy itself, there are financial incentives that work against the employer's goal of lowering costs. We see it everyday through employers paying outrageous inflated costs and employees choosing to pay cash over using their insurance to pay for meds. Thank you @USDOL